Mitnick In The News
If You Thought You Knew Exactly What Was Going to Happen at HIMSS17, You Might Have Been Wrong
The annual HIMSS Conference in Orlando brought with it a mix of predictability and surprises
After participating in 26 annual HIMSS Conferences—every year beginning with 1991, except for 1996—I think that some in our industry might allow me to apply a longitudinal gloss to the topic of the HIMSS Conference. And here’s the high-level on that longitudinal perspective: for a number of years, scattered individuals have stated their judgment that the annual HIMSS Conference is too big, too busy, and no longer relevant. And yet, every year, the HIMSS Conference surprises many by once again proving its relevance.
At the heart of the HIMSS Conference’s relevance is this simple reality: at a time of accelerating healthcare system change and policy and payment uncertainty, the need for healthcare and healthcare IT professionals to meet in person and touch base with one another has never been more important or more compelling.
And yes, the HIMSS Conference is huge these days: while on Monday at the HIMSS Media Lunch, HIMSS senior executives had announced 40,453 as the attendance this year, on Thursday, HIMSS Media Relations had been able revise that figure upwards to 42,287, nearly matching the record attendance two years ago at HIMSS15 in Chicago, which saw 43,043 attendees. So HIMSS is as big as it’s ever been. And there’s no sign it will be getting smaller anytime soon.
So what did we find out this year at HIMSS?
1. At a time of some policy uncertainty, the industry is moving forward towards value.
Everyone in healthcare knows that major policy changes are in the offing, with a change of presidential administration, after eight years under a single president and party. And Rep. Tom Price, who just before the HIMSS Conference began, became Secretary of Health and Human Services, has made it clear that he believes that healthcare is over-regulated, and in particular that physicians are over-regulated. So it’s clear that there will be a change of attitude on a broad level at HHS. But how that translates into reality at CMS (the Centers for Medicare and Medicaid Services) and ONC (the Office of the National Coordinator for Health IT) is another question altogether.
In that regard, perhaps one of the most interesting recent developments was one that didn’t take place at the HIMSS Conference, where the federal healthcare officials present were either Obama administration holdovers, or CMS and ONC staffers who had served in multiple past administrations, but who in any case had almost no leeway to reveal future policy directions (if they knew them) at CMS and ONC. But on Feb. 16, as Managing Editor Rajiv Leventhal noted in his report, Seema Verma, President Trump’s nominee as CMS Administrator, appeared before the Senate Finance Committee. As Leventhal noted in his report, Verma said on Feb. 16 that she applauds Congress for the passing of MACRA, while stating that she supports efforts “that hold providers accountable for outcomes and increasing the coordination of care. It’s another thing all together in having them take on risk,” she said. So it’s clues like that on which providers will have to rely, going forward, to divine what might happen to federal healthcare regulations going forward. Nonetheless, I heard not a single person participating in HIMSS17 state or imply that they believed that the core shift from volume to value in healthcare delivery and payment was going to be fundamentally reversed under the new administration or the current Congress.
Indeed, the one real news-making comment around federal healthcare policy at HIMSS17 came in the “opposite direction,” as it were, when former Speaker of the House of Representatives John Boehner said flatly during the keynote conversation on Thursday that he and former Pennsylvania Governor Ed Rendell had with HIMSS president and CEO Steve Lieber, that there would be no repeal of the Affordable Care Act (ACA), but instead, that Republicans would “fix” problems in the law and move on. Republicans in Congress, Boehner said, “are going to fix Obamacare—I shouldn’t call it repeal-and-replace, because it’s not going to happen,” he said, deriding all assertions that a full repeal will take place as “happy talk,” and adding that “In the 25 years I served in Congress, Republicans never agreed one single time on healthcare. When they started shouting repeal, repeal, and repeal, and then replace, I started laughing, because honestly, if you start with repeal, anything you pass after that is yours, you broke it.” That comment made national news that day.
And, when it comes to the future of meaningful use, Marc Probst, vice president and CIO of the Salt Lake City-based Intermountain Healthcare, told Leventhal very bluntly on Tuesday, when asked how optimistic he was about the current policy moment in health IT, “I am actually on the optimistic side because of the lack of clarity on the regulatory front. I think Meaningful Use is very unlikely to survive, at all,” he said. “I have been pushing for MU to be declared and done.”
2. Data security remains the ever-present threat. And is Blockchain the next “big thing”?
Of course, data and IT security remains top of mind for countless healthcare and healthcare IT leaders these days, particularly as the hackers become more and more professionalized; and that awareness was everywhere in discussions at HIMSS17. For example, as Assistant Editor Heather Landi reported, during a session entitled “Securing the Next-Generation Healthcare Enterprise,” Hussein Syed, chief information security officer at RWJBaranbas Health in New Jersey, noted that today’s hackers operate as professional organizations, “meaning they do a lot of planning and diligence before executing attacks. This means healthcare organizations must be equally proactive and thoughtful in how we assess the security of our organizations.”
In that context, Blockchain appeared to be the buzz-term of HIMSS17—it was referenced constantly by people I spoke with, among them Brian Ahier of Aetna/Medicity. As Ahier told me when we ran into each other on Wednesday, yes, Blockchain is overhyped right now; but at the same time, the first implementations incorporating it in healthcare are already happening, with many more to come. “One example,” he told me, “is around revenue cycle management: right now, solutions are being deployed. So I think we’re going to start to see things being deployed on the financial side, the business side, of healthcare.” And as Mac McMillan, founder and CEO of the Austin, Tex.-based CynergisTek consulting firm told me, “Blockchain has the capability and the potential to be transformative in healthcare. The technology is there. The question is, will it be adopted? there. The question is, will it be adopted? And will everyone invest in it? It won’t be enough for just the big vendors to invest in it; everyone will have to—all the vendors, and all the provider organizations. Otherwise, it will fail. It’s like anything else in healthcare: it will require real investment and adoption.”
In any case, the need for the healthcare industry to ramp up efforts to combat the evildoers is becoming more urgent by the day, as hackers’ abilities to leverage devastating technologies and strategies are growing every day now. And it was in that context that Kevin Mitnick, who went from the “dark side” to the good side, demonstrated at the CHIME-HIMSS Forum on Sunday how incredibly easy it is for skilled hackers to penetrate just about any information system. His live demonstration brought out literal gasps from the 700-plus CIOs and other healthcare IT leaders attending the CHIME-HIMSS Forum.
3. CMIOs are making their way forward through the weeds.
It was great to attend two sessions devoted to CMIOs, who are more than ever absolute nexus people in healthcare these days. And yet, CMIOs themselves say, they and their roles are often misunderstood, across the spectrum, on the part of their fellow physicians, as well as on the part of their fellow clinicians, on the part of non-clinical IT executives and professionals, and on the part of non-clinical administrators in hospitals, medical groups, and health systems.
Indeed, in a pair of educational sessions that followed each other in succession—first, “Medical Informatics and the C-Suite: Aligning Forces to Positively Affect Patient Care,” and then, the “CMIO Roundtable: Creating an Impactful Informatics Department,” CMIOs parsed some of the challenges and opportunities facing them individually, and as a group.
Howard Landa, M.D., CMIO of Alameda Health System in Oakland, California, touched on several key issues during the first panel session, when he said, “And those tactical roles—talk about the Quadruple Aim. How are we going to resource those efforts, while keeping the providers happy? And when you try to go to more standardized care, physicians immediately say, ‘What do you mean, I can’t have my own order sets?’ You need to have a clinician speaking to clinicians, so that they can understand what they really need to do. In order to be trusted that the decisions you’re making aren’t just to be cheaper, but that physician needs and the patient experience and the physician experience are in the forefront, that’s so important.” While all six medical informaticists touched on different aspects of their work, their challenges, and their opportunities, the common ground was the unique set of circumstances framing the CMIO role in the current moment in healthcare, and the huge opportunities available to them to lead clinical transformation in their organizations—if only they can get the time, resources, strategic and organizational support, staff, and a little bit of luck. As I’ve long said, CMIOs face unprecedented demands on them as absolute nexus leaders right now in informatics and organizational transformation.
4. Do CIOs feel encouraged by the progress made so far? Ed McAllister does.
In the midst of tumultuous change and countless demands on the time and expertise of today’s healthcare IT leaders, it might be easy to become discouraged personally or generally. But Ed McCallister, senior vice president and CIO at the vast UPMC health system in Pittsburgh, feels confident these days, and the reasons why are worth pondering. As he told me last week, “I’m actually extremely encouraged, because it seems more like a year of action than concept. In the past, we’ve talked about consumerism and other trends transforming healthcare. Now, I’m hearing about actions, such as the move to the cloud. In the past, we talked about, to cloud or not to cloud, and now we’re hearing about approaches.” He continued on to say that, “In the past, it was a technology discussion, without the recipient of the technology at the table. Now, we’ve actually engaged physicians, instead of just deploying EMRs. We were good at digitizing healthcare, but we didn’t change clinician workflow. And I think that finally, that slide that everyone’s seen about people, process, and technology, now make sense.”
I would also venture to say that the sessions and discussions at the CHIME-HIMSS Forum on Sunday gave one the impression that the 700-plus CIOs meeting at the Hyatt Regency at least have a broad sense of where they’re going generally. That’s not to say that all U.S. patient care organization CIOs are fully prepared for the future, or that they have their strategies laid out. Neither contentions would be true. But, given the policy and payment landscape, with the shift from fee-for-service to fee-for-value solidifying every week now, at least there is some clarity now in terms of the bigger picture in the industry.
5. Maps of the future: widely available.
Per that, I heard several excellent presentations at HIMSS17 that should have helped attendees get a firmer grasp on the future. One of the presentations that was outstanding was one presented by Todd Stewart, M.D. and Francis X. Campion, M.D. of Mercy Health-St. Louis entitled “Using Machine Intelligence to Reduce Clinical Variation,” on Tuesday. What those physician leaders and their colleagues are doing at Mercy-St. Louis is the reason why we named that organization the co-second-place winning team in our Healthcare Informatics Innovator Awards program this year. Indeed, their leveraging of machine learning capabilities to reduce clinical variation has saved an estimated $50 million in operating costs over the past three years. What’s great is that more and more patient care organizations are creating maps of their journeys ahead into clinical transformation and other forms of innovation, that are providing templates for action among their peer patient care organizations nationwide. Facilitating presentations like Mercy-St. Louis’s has always been a core element in the mix at the annual HIMSS Conference. I only wish that every presentation at the HIMSS Conference were at the level of Mercy’s.
6. Ginni Rometty’s speech… and what came after…
I would be remiss in this if I didn’t mention the electric speech on Monday of Ginni Rometty, president, chairman and CEO of the Armonk, N.Y.-based IBM. Her opening keynote address on Monday morning, before a packed audience of several thousand in the Valencia Ballroom, was vintage Ginni. I had seen her give a keynote last spring at the World Health Care Congress in Washington, D.C.; and while I was relieved that this was not a retread of that speech (we all know well-known speakers who give pretty much the same speech, over and over, to different audiences!), it did give the HIMSS17 audience the same sense of Rometty as a force of nature—a dynamic corporate leader who believes passionately in her organization and in one of its core initiatives—IBM Watson Health. Rometty spoke glowingly of Watson Health and its promise, and reassured her audience (as much as anyone can be reassured about such things in advance) that Watson Health would not be about displacing physicians and other healthcare professionals, but rather, about assisting them to be the best diagnosticians, etc., that they can be. So far so good. But then, as Managing Editor Rajiv Leventhal noted in his blog on Thursday, it has emerged in Forbes report released the day before Rometty's keynote, that “[T]he partnership between IBM and MD Anderson Cancer Center, part of the University of Texas, has soured to the point where the $62 million project for the cancer center to deploy Watson has been scratched. Bizarrely, the Forbes report noted that MD Anderson is still on the hook to pay for the whole thing and that its leader in charge of the project never got approval for the implementation from the center's IT department,” as Leventhal noted. I’m certain that eventually, much more about the MD Anderson situation will become known and understood. And we’ll just have to wait and see whether Watson’s Health promise is turned into full reality over time. But I certainly wouldn’t bet against this juggernaut of an initiative.
7. Looking forward (after a rest!) to HIMSS18 in Las Vegas…
So, the HIMSS Conference rolls forward. This was my twenty-sixth annual HIMSS Conference, and I can say unequivocally that each one has been worth attending. Are things ever perfect? Of course not. The quality of the educational sessions is inevitably somewhat uneven, with some amazing sessions and some pretty-far-from-amazing sessions, every year. Meanwhile, the critique of the conference as being far too commercial and too weighted in favor of the interests of the vendors is on target—and yet also, curiously, not entirely relevant, given the need for robust vendor participation in an industry sector that has always been driven by technology advancement. And of course, there are always minor glitches, problems, and weirdnesses. Take for example, the almost surreally stupid decision on the part of someone to hire a DJ to play loud rock and pop music from a little booth in the largest and most central atrium area in front of one entrance to the exhibit hall, and, coincidentally, just below the Press Room and other important meeting rooms. The result was that, a few hours a day, we had the “pleasure” of ludicrously blasted music—in a hyper-resonant physical space—adding further noise and distraction to what is always and inevitably a noisy and distracting convention setting. My advice to the HIMSS folks for next year? CAN THE DJ. Thank you.
But, back to the big picture: for years now, people have been saying that the HIMSS Conference is too big, too diffuse, too noisy, too busy, and that it either is or is becoming, irrelevant. In fact, my perspective is that the conference is more relevant than ever. People in healthcare and healthcare IT need to touch base in person more than ever before, as much as they already connect online, in conference calls and webinars, and in smaller settings than the annual HIMSS Conference. We at Healthcare Informatics find that those participating in our Health IT Summit series are exceptionally eager to connect with one another live, as the pace of change in healthcare outstrips people’s ability too quickly and readily process what’s going on. And so every setting, from the online to the telephonic to the smaller-conference setting, to every-size setting up to the gigantic annual HIMSS Conference—whose final attendance was tallied at 42,287 on Thursday—is of value. And that includes this biggest annual gathering in healthcare IT. For all its flaws, the annual HIMSS Conference remains a needed event in healthcare, and one that can and does offer surprises every year.
With that, I look forward to being surprised again at HIMSS18 in Las Vegas. Let’s just hope they forget the DJ next time!
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